- Health experts say it is important for Medicare recipients to compare plans during the current open enrollment period.
- They note that some monthly insurance premiums may increase slightly while others may see minor decreases.
- They add that there could be changes in medical services coverage as well as deductibles and out-of-pocket expenses.
Experts are urging Medicare recipients to carefully research their options for next year during the open enrollment period that is now under way.
They say changes in premiums and other Medicare components as well as the government shutdown could affect what they pay for medical care as well as what services are available to them.
“Millions of Medicare beneficiaries will face higher out-of-pockets costs and reduced benefits in 2026, so comparing Medicare coverage options is especially crucial this year,” Whitney Stidom, vice president of consumer enablement at eHealth, told Medical News Today.
“Beneficiaries should be proactive during the Medicare annual enrollment period, as comparing plans from multiple insurers can help people save money and find the right option for them,” Stidom added.
The open enrollment period for Medicare began on October 15 and lasts until December 7.
This eligibility window is for people 65 years and older who want to sign up for the federally funded health program or make changes to their current plans.
In addition to the usual considerations, there also may be some uncertainties added this year if the federal government shutdown lasts for an extended period of time.
One is that the processing of claims by recipients and payments to medical providers could be delayed.
Another is that telehealth services could be reduced. Some telehealth programs that were offered over the past several years expired on October 1 and Congress did not take action to renew them.
“TeleHealth restrictions will lead to gaps in access for many patients, especially those who are dealing with disabilities or those living in rural areas,” said Kanwar Kelley, MD, a specialist in otolaryngology head and neck surgery, obesity medicine, and lifestyle medicine as well as the co-founder and chief executive officer of Side Health in Orinda, CA.
“Converting patients accustomed to teleHealth back to in-person visits will incur costs for transportation, lost work, and time,” Kelley told MNT. “Patients with mobility issues, rural travel barriers, or caregiver constraints — who benefited most from teleHealth — may face greater costs and logistical hurdles to get needed care, and delayed or avoided care can increase downstream costs and worse outcomes.”
About 69 million people in the United States get health coverage under the Medicare system.
About 90% of those covered are 65 years or older. Most of those under 65 are people with specific disabilities.
Basic Medicare coverage includes what is known as Part A and Part B.
Part A covers inpatient care at hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home healthcare. It is estimated that only 1% of people on Part A pay a monthly premium.
Part B covers necessary medical services such as doctor’s visits, outpatient care, and ambulance services. Premiums are usually deducted from a person’s monthly Social Security check.
An estimated 51% of Medicare recipients have supplemental health insurance such as a Medicare Advantage plan.
The Centers for Medicare & Medicaid Services (CMS) estimate there will be about 5,600 Medicare Advantage Plans available nationwide in 2026. That is close to the numbers from 2025, when the amount of options decreased from the previous year.
The number of plans available to an individual Medicare recipient varies from state to state.
In addition, some Medicare Advantage providers, including UnitedHealthcare, have said they plan to scale back their service areas and/or coverage options.
The average Part B premium is expected to rise from $185 in 2025 to $206 in 2026. That 12% increase would be twice as high as the 2025 hike.
It would also more than offset the projected 2.7% increase in Social Security monthly benefits paid to individuals.
One reason given for these increases is that people are utilizing Part B coverage more often, resulting in lower profits for Health insurance firms. In addition, more people are enrolling in Part B plans. There are also higher costs in general for hospitalization and outpatient care.
At the same time, it is projected that the average monthly premium for Medicare Advantage plans with prescription drug coverage will decrease from $16 in 2025 to $14 in 2026.
In addition, the CMS estimates that monthly premiums for standalone Part D plans will drop from $38 in 2025 to $34 in 2026. Premiums for Part D that are part of Medicare Advantage plans will dip slightly from $13 to $11 per month.
However, insurance companies will be allowed to raise Part D premiums as much as $50 per month, higher than the current $35 monthly maximum.
Experts say Medicare recipients will feel the effects of any premium increases.
“Any cost increase to medical premiums will be significant as prices are rising for other goods and services. In the end, it means less money in consumers’ pockets,” said Kelley.
The annual out-of-pocket limit for in-network services for Medicare Advantage recipients will decrease slightly from $9,350 in 2025 to $9,250 in 2026.
The annual cap on out-of-pocket expenses for Part D drugs will increase slightly from $2,000 in 2025 to $2,100 in 2026.
The maximum out-of-pocket cost for insulin will remain at $35 per month and most vaccines will still be covered under Part D.
However, earlier this year the Trump administration decided against Medicare covering the cost of GLP-1 weight-loss drugs such as Ozempic.
At the same time, the annual deductible for Part B medical coverage is projected to rise 12% in 2026 to $288.
The annual deductibles for Part D coverage are also expected to increase. Those amounts can vary, but the maximum any plan can charge will rise from $590 in 2025 to $615 in 2026.
Experts say any increases in deductibles or out-of-pocket costs will be felt.
“Changes to their deductibles, copays, and coinsurance can have a big impact on Medicare beneficiaries, especially for people who live on a fixed income. It is important that beneficiaries are confident they can afford the medical care they will need in case of an unforeseen illness or injury.”
– Whitney Stidom
It is estimated that about 81% of Medicare recipients are also enrolled in Part D, which covers prescription drug expenses.
The number of standalone Part D plans is forecasted to decrease from 464 nationwide in 2025 to 360 in 2026. Medicare officials are expected to continue to negotiate prices for drugs covered under Part D.
Experts say that could result in discounts of 38% to 79% on list prices on 10 widely used prescriptions, including blood thinners Eliquis and Xarelto, as well as diabetes medications Januvia, Jardiance, and Farxiga.
People with Part D plans will also continue to be able to utilize an automatic prescription payment plan that spreads out drug costs over the year. People who currently have this plan will be automatically re-enrolled for 2026 unless they opt out.
Despite these price reductions, experts say some Medicare recipients could still pay more for prescription drugs.
“Although the price of Part D (drug benefits) may reduce overall, the reduction in options and changes to covered medications could result in higher costs for consumers of certain specialty medications,” Kelley noted.
An estimated 70% of Medicare recipients do not currently compare plan options.
Experts say it is important for Medicare recipients to research options and study different plans during the open enrollment period to see what is best for them financially as well as which medical services are covered.
Stidom noted that consumers should have recently received an annual “notice of change” letter from their Medicare Advantage and Part D providers, informing what will be different in 2026.
She said using a licensed insurance agency such as eHealth can save consumers as much as $1,800 a year.
“For help finding coverage, Medicare beneficiaries can start online with a private marketplace, which can help people compare plans side by side from multiple insurers,” she said. “Some websites make it convenient to compare Medicare Advantage plans based on various factors, including personal health needs, locations, prescribed drugs, and more.”
Stidom also recommended Medicare recipients closely check their Part D plans “because these plans are offered through private insurers, the year-over-year premium changes can vary.”
“Some enrollees may also see changes to their list of covered drugs or to the drug tiers that determine what patients pay for them out of pocket,” she noted.
